上尿路尿路上皮癌腹腔镜下基于模板的淋巴结清扫术的价值初探(附52例报道)

Preliminary discussion on template-based laparoscopic lymph node dissection for upper tract urothelial carcinoma discussion(reported of 52 cases)

目的初步探讨基于模板的腹腔镜下淋巴结清扫术在上尿路尿路上皮癌治疗中的价值。方法收集我科2016年9月至2021年9月收治的随访资料完整的52例行肾输尿管及膀胱袖状切除术的上尿路尿路上皮癌患者的临床资料,其中同期行腹腔镜下基于模板的淋巴结清扫术18例,未行淋巴结清扫术34例,对比分析两组的术后随访和生存情况。结果同期行基于模板的淋巴结清扫与未清扫组对比,累积生存率分别为83.3%和55.9%(P=0.025);病理分期≥pT 2患者中,累积生存率分别为83.3%和50.0%(P=0.012);淋巴结清扫是上尿路尿路上皮癌预后的保护因素(HR=0.650,95%CI=0.072~0.921,P=0.037)。结论同期行基于模板的腹腔镜下淋巴结清扫术,对上尿路尿路上皮癌,特别是病理分期≥pT 2的患者,生存可能获益。

Objective To investigate the value of template-based laparoscopic lymph node dissection in the treatment of upper tract urothelial carcinoma.Methods The clinical data of 52 patients with complete follow-up data from September 2016 to September 2021 diagnosed as upper tract urothelial carcinoma were collected.They all underwent nephroureterectomy combined with bladder sleeve resection.Eighteen of them were performed template-based laparoscopic lymph node dissection(LND)at the same time,while 34 of them were not.Postoperative follow-up and survival data of these two groups were analyzed and compared.Results The cumulative survival rate of LND and NLND were 83.3%and 55.9%(P=0.025).The cumulative survival of LND and NLND in patients with pathological stage≥pT 2 were 83.3%and 50.0%(P=0.012).It showed lymph node dissection was a protective prognostic factor for upper tract urothelial carcinoma(HR=0.650,95%CI=0.072-0.921,P=0.037).Conclusions Simultaneous template-based laparoscopic lymphatic dissection may benefit patients with upper tract urothelial carcinoma,especially in pathological stage≥pT 2.